What’s the relative cost of in-patient vs. out-patient care?
In home care even with 8 to 24h nursing can be had for a similar price or lower than a skilled nursing facility ($50-100/hr) with much better quality of life and lower risk of infection if you go to reasonable efforts to keep it clean.
A hotel can easily provide room and board (essentially the services of a hospital's basic in-patient care) for <$100 a night. The hospital also has a ton of equipment and staff that are additional, but how can it possibly be as much as $1900-$4900? I feel like in-patient care is similar to a hotel but with extra stuff that might increase the cost by a factor of (perhaps) 2-5. But not 10-25. That would suggest that there's some major inefficiency in hospitals causing the cost bloat. You said the price is before doctors, medications, tests, etc. so the service is essentially just accomodation. How can it be so expensive?
Then you can start throwing in the inflated costs due to the American insurance system, the higher liability hospitals have compared to hotels, and other factors. I'm sure people more familiar with the medical profession could add even more exacerbating factors that I don't know about. All of this isn't to say that the hospital or healthcare system isn't inefficient, but simply that hospitals and hotels are apples and oranges.
As a side question, does anyone know how to convert 2012-GBP into 2018-USD under PPP?
You're in hospital because your condition is such that you might need emergency high-grade medical attention on moments notice. If you don't, you're better off going home (or, indeed, checking in to a hotel).
Try to work out what a hotel would cost that would serve you and ten guests en eight course haute cuisine tasting menu from your choice of five different cuisines at 15 minutes notice at any point during the day or night, and you're closer to the answer.
"Many patients are never informed of their hospital status, and physicians say the care provided does not depend on status. However, the status change can have a major impact on patient costs:
- Hospital stay costs: Medicare pays significantly more for inpatient stays—which fall under Part A of the federal program—than for observation stays—which fall under Part B. As such, much of the cost of a Part B hospital stay fall to the patient.
- Post-discharge care costs: Medicare does not cover post-discharge care for Part B observation stays. As such, a patient who is placed on observation status for a broken bone will have to pay the full cost of rehabilitation. In comparison, Medicare pays for skilled nursing care following an inpatient stay that lasted at least three consecutive days. However, patients who are shifted into inpatient status after spending days in observation status must spend three full days in inpatient status to receive the benefit (the time spent in observation status does not count toward the three-day requirement)."
https://www.unitedmedicareadvisors.com/inpatient-and-outpati...
They're not directly comparable, because the care delivered is fundamentally different, but inpatient care is about two orders of magnitude more expensive.
That's not to say that reduction of inpatient care is always a goal, though, because it's only a good tradeoff when the outpatient care actually would provide equivalent or better clinical outcomes. Sometimes that's true, sometimes it's not.
What are a couple of the major factors driving such a huge difference?
It used to be more common to keep patients at the hospital just in case, but they now send patients home in many of those cases. In my (unprofessional) opinion, this is a good thing. Recovery is much easier in the comfort of our own home, without the stress of being woken up at all hours of the night for tests. We're also completely avoiding a huge risk -- hospital borne infections.